for the routine administration of vaccines to children and adults in the civilian population. The ACIP recommendations for who should receive the hepatitis B vaccine are summarized in Box 4-1. The American Academy of Pediatrics in its Report of the Committee on Infectious Diseases follows the ACIP recommendations for the hepatitis B vaccine (American Academy of Pediatrics, 2009).

Perinatal Vaccination

ACIP first recommended universal hepatitis B vaccination of infants in 1991 (ACIP, 1991). Despite the recommendation, each year about 1,000 newborns in the United States acquire chronic HBV infection (Ward, 2008), a number that has not declined in the last decade. That constitutes an important gap that needs to be addressed in future prevention efforts.

ACIP currently recommends that the first dose—that is, the birth dose—be administered before hospital discharge in infants born to HbsAg-negative women and within 12 hours of birth in infants born to women who are HbsAg-positive or of unknown status (Mast et al., 2005). It also recommends that infants born to HBsAg-positive mothers should be given HBIG within 12 hours of birth. There is no evidence of appreciable benefit if HBIG is administered more than 72 hours after birth. The timely identification of HBsAg-positive mothers to prevent perinatal transmission underscores the need for rapid hepatitis B tests (discussed further in Chapter 5). The hepatitis B vaccine series should be completed by the age of 18 months (see Table 4-1). Depending on which type of vaccine (single-antigen or combination) is administered, the series can consist of three or four vaccinations.

Current ACIP hepatitis B vaccine recommendations for preterm infants who weigh less than 2,000 g are summarized in Table 4-2. For preterm infants, the first dose of the vaccine is given within 12 hours of birth if the mother is HBsAg-positive or is of unknown status. If the mother is known to be HbsAg-negative, the first dose is administered at the age of 1 month or at hospital discharge (Mast et al., 2005). The preterm-infant schedule is based on the recognition that preterm infants have a decreased response to hepatitis B vaccine administered before the age of 1 month.

Data from National Immunization Surveys demonstrate that national newborn hepatitis B vaccination coverage did not change appreciably after implementation of the 2005 ACIP hepatitis B vaccination recommendation (CDC, 2009b). Using National Immunization Survey data that were collected before implementation of the 2005 ACIP hepatitis B vaccination recommendation, CDC estimated that the national newborn hepatitis B vaccination coverage was 46%, 47.9%, and 42.8% at the age of 1 day in the 2004, 2005, and 2006 surveys (CDC, 2008c, 2009b). Using data



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